<form action="cupactions/action-mediarequest&$typename2=$cupID&clanID=$clanID&matchID=$matchID" method="post" name="post">
	<table width="100%" cellspacing="$cellspacing" border="0" cellpadding="$cellpadding" bgcolor="$border">
		<tr> 
			<td align="center" class="title">%matchmedia_requested_title%</td>
		</tr>
		<tr>
			<td colspan="2" bgcolor="$pagebg"></td>
        </tr>
		<tr>
			<td bgcolor="$bg1">
				<table width="100%" border="0" align="center" cellpadding="$cellpadding" cellspacing="$cellspacing">
					<tr> 
						<td>Text:</td>
						<td><input name="reason" type="text" class="form_off" id="reason" onFocus="this.className='form_on'" onBlur="this.className='form_off'" size="35"></td>
					</tr>
					<tr> 
						<td colspan="3"><hr noshade size="1" color="$border"></td>
					</tr>
					<tr>
						<td colspan="3" align="right">
						<input name="post" type="submit" value="%save%"></td>
					</tr>
				</table>
			</td>
		</tr>
	</table>
</form>